Where is the "lesions"? What is the "lesions"? are still the two famous questions
of neurology practice taught in classic teaching. The issue of "LESIONS" in neurology is
fascinating. The fascination has driven designing a game that mimics the neurology classic
approach for looking for a "LESION" (London Z and Burke J, online). Also lesions seem to
preoccupy many neurologists’ practice. This has been transmitted to their patients e.g. a blog
about living with Multiple Sclerosis (MS) in called the "The Lesion Journals" (Christie, online).
May be because persons with MS when they meet their neurologists, the focus of the meetings is
always the "LESIONS". Some neurologists even picture the lesions localizations’ as “building a
case for the verdict =diagnosis you believe the patient has” (Zazulia AR, online). There is
nothing wrong in this approach in neurology and it has been working for more than a century.
But other things rather than lesion matter especially in other medical specialties.
After attending a CME activity on Cardiac MRI imaging clinical uses, one starts to think that the
"LESION" approach is also invading cardiology practice. Actually Cardiac MRI has made a
dramatic leap on knowing where and what are many lesions. But is this effect accompanied by a
dramatic improvement on how we provide care to our cases carrying these "Lesions"? After a
thought, the situation was found to be present in some other clinical practices.
Concentrating on the lesions extent and its nature is a good thing to do; but is it the best thing to
do? Without any offenses, but some new generations of cardiologists and other medical
practitioners are losing the whole point of medicine: "persons not lesions". They are making
huge (and time costly, uncomfortable, and expensive at many times) efforts to find the lesion site
and to know its nature but tend to miss the "Holistic nature" of practicing medicine. Actually
medicine is still handicapped when it goes to the management of some disorders as genetic
disorders, Amyloidosis, and Sarcoidosis. I am not saying that we do not have interventions to
provide, but that interventions are limited in their effect over the natural history of the diseases in
those disorders.
On the contrary, drug companies and medical investigations are focusing on making clinicians
"preoccupied" with the "lesions" part rather than the whole picture. The role of Academic and
research institutes is to overcome this approach and to keep focus on keeping the "holistic
approach" as the standard practice. Hospitals need to invest more in the holistic approach rather
than the lesionists approach. I hope we all look and ask for impacts of the new investigations or
medications on the holistic approach and not get fascinated by the "Lesion" approach. This is
actually one of the points that confirms the value of comprehensive geriatric assessment and
multidisciplinary approaches in geriatrics practice. Mainly because "for a given geriatric
syndrome, multiple risk factors and multiple organ systems are often involved .... diagnostic
strategies to identify the underlying causes can sometimes be ineffective, burdensome,
dangerous, and costly …. therapeutic management of the clinical manifestations can be helpful
even in the absence of a firm diagnosis or clarification of the underlying causes" (Studenski S, Tinetti ME, et al., 2007). In Geriatric syndromes we might not be able to catch or
just concentrate on a main suspect and follow the leads of evidence, but rather handling the
“case” itself from the start is a better approach. Geriatric health care providers should be ware
not to be a "Lesionists" while encountering any elderly with a cardiac or neurologic disorder or
any other disorder, until the evidence is formulated to tell us how much to investigate any lesion.
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